Individual
E. WADE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LPC
Contact information
Practice address
111 E 16TH ST, IDAHO FALLS, ID 83401
(208) 523-1130
(208) 529-6501
Mailing address
111 E 16TH ST, IDAHO FALLS, ID 83401
(208) 523-1130
(208) 529-6501
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC - 161
ID
1041C0700X
Clinical Social Worker
Primary
LCSW - 348
ID
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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